Countdown to Obamacare

Ron Pollack

The countdown has started. In about 100 days, starting Oct. 1, millions of families across the nation will have an opportunity to enroll in health coverage through the Affordable Care Act (ACA), also known as Obamacare.

The full benefits of the law will be most apparent and available to residents of Maryland. This is because Maryland, thanks to its more active role in implementing the historic health reform law, is expected to be one of the model states for the rest of the nation. As a result, Maryland will demonstrate the vast potential benefits of the ACA.

Here are some other things about the law to watch for, as we approach and pass the Oct. 1 milestone.

First, the public's focus on the ACA will become increasingly personal and decreasingly political. The closer we get to Oct. 1, the more families will shift their focus to the nuts and bolts of the new law and how it affects their lives. They will be able to pick and enroll in a health plan, and, for the first time, get financial help to reduce out-of-pocket premium costs.

Families that can't pay for health coverage today will be looking for details about the new premium subsidies that will make health insurance much more affordable.

Consumers seeking increased value for their health care dollars will learn how new insurance marketplaces give them real and meaningful choices — choices that enable consumers to select health plans best suited for their needs, with access to physicians they trust.

People with diabetes, asthma, or cancer — whether they have coverage or will be looking for it — will seek assurance that insurance companies can no longer deny coverage, or charge discriminatory premiums, due to their pre-existing conditions.

While some Republican leaders vow that the ACA will be a top issue in the 2014 elections, political rhetoric will become a sideshow as we move closer to Oct. 1: What will really matter will be how the ACA, in the most practical ways, affects the lives of Marylanders and other American families.

Second, there will be significant and perceptible differences from one state to another in terms of health coverage, costs, and quality of care — with states like Maryland, that actively participate in all provisions of the law, faring much better.

These differences between states will show up in a number of ways. For example, states that accept generous federal funding to expand Medicaid coverage for low-income families will show remarkable improvements in reducing uninsured rates. States that turn a cold shoulder to people who need help the most won't see these reductions.

States with larger numbers of on-the-ground helpers, sometimes called "navigators" or "assisters," will help their citizens much more effectively to secure premium subsidies and to obtain coverage that is most responsive to their families' needs.

And states that implement active oversight of their insurance marketplaces will do appreciably better in decelerating decades of premium increases.

Third, prospective and actual advances among active, cooperating states like Maryland will slowly but surely lead to less recalcitrance among governors and legislators in states that heretofore resisted, or even obstructed, the ACA's implementation.

Already, eight conservative governors — Jan Brewer of Arizona, Chris Christie of New Jersey, Jack Dalrymple of North Dakota, John Kasich of Ohio, Susana Martinez of New Mexico, Brian Sandoval of Nevada, Rick Scott of Florida, and Rick Snyder of Michigan — have declared their support for the Medicaid expansion, understanding that it would be an act of fiscal malpractice to turn down this federal funding. And when other benefits of ACA implementation in active states become clearer, additional Republican governors will want to follow their lead.

As a result, effective implementation of the new health reform law will spread throughout the country, and this will enable our nation to move closer to affordable, quality health coverage and care for all Americans.

Ron Pollack is the founding executive director of Families USA and the founding board chair of Enroll America, an organization seeking to enroll all uninsured Americans in health coverage. He may be contacted at info@familiesusa.org.